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TOPLINE:

In patients with irritable bowel syndrome (IBS), a dietitian-guided 12-week strict low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (LFD) improves quality of life (QoL) without altering nutritionally related blood parameters or macro- and micronutrient intake.

METHODOLOGY: 

• Patients with IBS whose disease severity improves upon adopting an LFD for 2-6 weeks usually follow it for longer to prevent flare-ups, although it's unknown whether this approach leads to nutritional deficiencies, weight loss, and decreased QoL.
• Researchers evaluated the safety of an extended LFD program on the measures of blood biochemistry, nutritional status, symptom severity, and QoL in this sub-study of the Bergen BrainGut project.
• Between May 2019 and July 2021, researchers prospectively enrolled participants with moderate to severe IBS and diarrhea or mixed stool patterns who followed a 12-week strict LFD intervention guided by a registered dietitian.
• Information on dietary intake was assessed using a 3-day dietary record provided by the participants at baseline and after 12 weeks.
• Blood samples were collected, body weight was measured, and IBS severity and QoL were assessed at baseline and after 4 weeks (body weight and IBS severity only) and 12 weeks.

TAKEAWAY:

• Thirty-six participants (mean age, 37 years; 67% women; 75% with moderate IBS; and 25% with severe IBS) completed the intervention.
• Compared with baseline, the LFD intervention did not lead to any change in the nutritional parameters or micro- and macronutrient intake at 12 weeks; however, intake of 10 micronutrients (riboflavin, folate, vitamins C and D, iron, calcium, magnesium, potassium, selenium, and iodine) was below the recommended levels at both baseline and after 12 weeks.
• Mean body mass index (BMI) decreased by 0.5 points (P < .001) post-LFD, with a greater weight reduction observed in those whose BMI was > 25 at baseline.
• The median IBS symptom severity score changed from moderate (245) at baseline to mild (121) at week 12 (P ≤ .001), with 80% of patients classified as responders to the 12-week LFD intervention.
• The overall QoL score increased from 59 to 70 after the LFD intervention, with improvements observed in most domains (P ≤ .012 for all), except for food avoidance and social reaction.

IN PRACTICE:

"Our results therefore indicate that an extended LFD, when guided by a dietitian, is not inferior to the participants' baseline diet," the authors wrote. "A registered dietitian is important to evaluate a patient's nutritional status and give individualized guidance on the implementation of dietary advice for IBS for adequate symptom relief while simultaneously achieving a good diet quality."

SOURCE:

The study, led by Eline Margrete Randulff Hillestad, MS, Department of Clinical Medicine, Faculty of Medicine, Center for Nutrition, University of Bergen, Bergen, Norway, was published online in Neurogastroenterology & Motility.

LIMITATIONS:

There was no control group in this open-label intervention, and analyses relying on dietary records are prone to bias. Seasonal variations may have affected nutrient intake and circulating vitamins, such as vitamin D. The inclusion of fewer patients than planned, owing to the pandemic combined with the participants lost to follow-up, may have affected the statistical power of the analyses.

DISCLOSURES:

The study was supported by the Norwegian Research Council, Helse Vest Research Funding, and Foundation Dam. The authors declared no conflicts of interest.